Duration of Fasting, Serum Lipids, and Metabolic Profile in Early Childhood

  • Laura N. Anderson
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

    Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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  • Jonathon L. Maguire
    Affiliations
    The Applied Health Research Center of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada

    Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Gerald Lebovic
    Affiliations
    The Applied Health Research Center of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Anthony J. Hanley
    Affiliations
    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Jill Hamilton
    Affiliations
    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada

    Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Khosrow Adeli
    Affiliations
    Division of Clinical Biochemistry, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Brian W. McCrindle
    Affiliations
    Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada

    Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Cornelia M. Borkhoff
    Affiliations
    Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Patricia C. Parkin
    Affiliations
    Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada

    Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Catherine S. Birken
    Affiliations
    Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada

    Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • on behalf ofThe Applied Research Group for Kids! (TARGet Kids!) Collaboration
    Author Footnotes
    * List of additional collaborators of TARGet Kids! is available at www.jpeds.com (Appendix).
  • Author Footnotes
    * List of additional collaborators of TARGet Kids! is available at www.jpeds.com (Appendix).
Published:October 11, 2016DOI:https://doi.org/10.1016/j.jpeds.2016.09.005

      Objectives

      To evaluate the association between fasting duration and lipid and metabolic test results.

      Study design

      A cross-sectional study was conducted in healthy children aged 0-6 years from The Applied Research Group for Kids! (TARGet Kids!) primary care practice network, Toronto, Canada, 2008-2013. The associations between duration of fasting at blood collection and serum lipid tests and metabolic tests were evaluated using linear regression.

      Results

      Among 2713 young children with blood tests the fasting time ranged from 0 to 5 hours (1st and 99th percentiles). Fasting duration was not significantly associated with total cholesterol (β = 0.006; P = .629), high-density lipoprotein (HDL) (β = 0.002; P = .708), low-density lipoprotein (β = 0.0013; P = .240), non-HDL (β = 0.004; P = .744), or triglycerides (β = −0.016; P = .084) adjusted for age, sex, body mass index, maternal ethnicity, and time of blood draw. Glucose, insulin, and homeostasis model assessment of insulin resistance were significantly associated with fasting duration, and the average percent change between 0 and 5 hours was −7.2%, −67.1%, and −69.9%, respectively. The effect of fasting on lipid or metabolic test results did not differ by age or sex; HDL and triglycerides may differ by weight status.

      Conclusions

      In this cohort of healthy young children, we found little evidence to support the need for fasting prior to measurement of lipids. The effect of fasting on glucose was small and may not be clinically important. When measuring serum lipid tests in early childhood, fasting makes a very small difference.

      Trial registration

      ClinicalTrials.gov: NCT0186953.

      Keywords

      Abbreviations:

      BMI ( Body mass index), HDL ( High-density lipoprotein), HOMA-IR ( Homeostasis model assessment of insulin resistance), LDL ( Low-density lipoprotein), NHANES ( National Health and Nutrition Examination Surveys), TARGet Kids! ( The Applied Research Group for Kids!), zBMI ( BMI z-score)
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      References

        • National Heart Lung and Blood Institute
        Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        Pediatrics. 2011; 128: S213-56
        • Morrison J.A.
        • Friedman L.A.
        • Gray-McGuire C.
        Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study.
        Pediatrics. 2007; 120: 340-345
        • Magnussen C.G.
        • Venn A.
        • Thomson R.
        • Juonala M.
        • Srinivasan S.R.
        • Viikari J.S.
        • et al.
        The association of pediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima-media thickness in adulthood evidence from the cardiovascular risk in Young Finns study, the Bogalusa Heart study, and the CDAH (Childhood Determinants of Adult Health) study.
        J Am Coll Cardiol. 2009; 53: 860-869
        • Yajnik C.S.
        • Katre P.A.
        • Joshi S.M.
        • Kumaran K.
        • Bhat D.S.
        • Lubree H.G.
        • et al.
        Higher glucose, insulin and insulin resistance (HOMA-IR) in childhood predict adverse cardiovascular risk in early adulthood: the Pune Children's Study.
        Diabetologia. 2015; 58: 1626-1636
        • Third Report of the National Cholesterol Education Program (NCEP)
        Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • De Backer G.
        • Ambrosioni E.
        • Borch-Johnsen K.
        • Brotons C.
        • Cifkova R.
        • Dallongeville J.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.
        Eur Heart J. 2003; 24: 1601-1610
        • Sidhu D.
        • Naugler C.
        Fasting time and lipid levels in a community-based population: a cross-sectional study.
        Arch Intern Med. 2012; 172: 1707-1710
        • Mora S.
        • Rifai N.
        • Buring J.E.
        • Ridker P.M.
        Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events.
        Circulation. 2008; 118: 993-1001
        • Langsted A.
        • Freiberg J.J.
        • Nordestgaard B.G.
        Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction.
        Circulation. 2008; 118: 2047-2056
        • van Veen M.R.
        • van Hasselt P.M.
        • de Sain-van der Velden M.G.
        • Verhoeven N.
        • Hofstede F.C.
        • de Koning T.J.
        • et al.
        Metabolic profiles in children during fasting.
        Pediatrics. 2011; 127: e1021-7
        • Walter J.H.
        Tolerance to fast: rational and practical evaluation in children with hypoketonaemia.
        J Inherit Metab Dis. 2009; 32: 214-217
        • Steiner M.J.
        • Skinner A.C.
        • Perrin E.M.
        Fasting might not be necessary before lipid screening: a nationally representative cross-sectional study.
        Pediatrics. 2011; 128: 463-470
        • Pasic M.D.
        • Colantonio D.A.
        • Chan M.K.
        • Venner A.A.
        • Brinc D.
        • Adeli K.
        Influence of fasting and sample collection time on 38 biochemical markers in healthy children: a CALIPER substudy.
        Clin Biochem. 2012; 45: 1125-1130
        • Carsley S.
        • Borkhoff C.M.
        • Maguire J.L.
        • Birken C.S.
        • Khovratovich M.
        • McCrindle B.
        • et al.
        Cohort profile: the Applied Research Group for Kids (TARGet Kids!).
        Int J Epidemiol. 2015; 44: 776-788
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Rourke L.
        • Leduc D.
        • Constantin E.
        • Carsley S.
        • Rourke J.
        • Li P.
        Getting it right from birth to kindergarten: what's new in the Rourke Baby Record?.
        Can Fam Physician. 2013; 59: 355-359
        • de Onis M.
        • Garza C.
        • Victora C.G.
        The WHO Multicentre Growth Reference Study: strategy for developing a new international growth reference.
        Forum Nutr. 2003; 56: 238-240
        • Secker D.
        Promoting optimal monitoring of child growth in Canada: using the new WHO growth charts.
        Can J Diet Pract Res. 2010; 71: e1-3
        • Ridker P.M.
        Fasting versus nonfasting triglycerides and the prediction of cardiovascular risk: do we need to revisit the oral triglyceride tolerance test?.
        Clin Chem. 2008; 54: 11-13